ORIGINAL RESEARCH Posttraumatic Stress Disorder in Pregnancy: Prevalence, Risk Factors, and Treatment Cynthia A. Loveland Cook, PhD, Louise H. Flick, DrPH, Sharon M. Homan, PhD, Claudia Campbell, PhD, Maryellen McSweeney, PhD, and Mary Elizabeth Gallagher, PhD OBJECTIVE: To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvan- taged pregnant women. METHODS: The sample included 744 pregnant Medicaid- eligible women from Women, Infants and Children Sup- plemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmen- tal stressors, and pregnancy characteristics. Logistic regres- sion identified risk factors associated with posttraumatic stress disorder. RESULTS: Posttraumatic stress disorder prevalence was 7.7% (n  57/744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.61, 10.26) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported mod- erate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months. CONCLUSIONS: The prevalence of posttraumatic stress disor- der in pregnancy and low treatment rates suggest that screen- ing for this disorder should be considered in clinical practice. (Obstet Gynecol 2004;103:710 –7. © 2004 by The American College of Obstetricians and Gynecologists.) LEVEL OF EVIDENCE: II-2 A basic premise of obstetric practice is to optimize preg- nancy outcomes through preventive and ameliorative treatment. One area of clinical practice gaining increas- ing attention is the mental health of pregnant women and its effect on birth outcomes. Community prevalence studies estimate that 20 –30% of all women experience at least one psychiatric disorder in a given year. Women of childbearing age have even higher reported rates. 1–3 One psychiatric disorder affecting a disproportionate number of women of childbearing age is posttraumatic stress disorder, with lifetime rates ranging from 10.4% to 13.8%. 4–7 People diagnosed with posttraumatic stress disorder usually have experienced or witnessed life-threatening trau- matic events that elicit feelings of horror, terror, and fear. 8 For women, the precipitating events most often are rape, childhood physical abuse, physical assault, or being threat- ened with a weapon. 4,5,7 A large proportion of women experience trauma before the age of 25 years. 6 Common symptoms of posttraumatic stress disorder include intru- sive recollections of the traumatic stressor, avoidant/ numbing behaviors, and hyper-arousal symptoms. 8 Little research has focused on posttraumatic stress disorder in pregnancy to estimate either its prevalence or the likelihood of treatment for the disorder. Conse- quently, this study aims to estimate the prevalence of posttraumatic stress disorder in economically disadvan- taged pregnant women, describe the proportion of women receiving treatment, and identify the associated risk factors that can facilitate screening for the disorder in clinical practice. MATERIALS AND METHODS Using a prospective cohort design, we recruited 744 pregnant Medicaid-eligible women at Women, Infants and Children Supplemental Nutrition Program sites in the city of St. Louis and in 5 rural counties in southeast- ern Missouri. Both areas have high levels of poverty and rates of infant mortality and low birth weight infants that exceeded national averages at that time. The sample was limited to black and white women, because they make up the vast majority of the population in both geographic From Saint Louis University, St. Louis, Missouri; and Tulane University, New Orleans, Louisiana. This research was funded by the National Institute of Mental Health (R01/ MH57736-03), SLU2000 Research Initiative, and Saint Louis University Beaumont Award. VOL. 103, NO. 4, APRIL 2004 710 © 2004 by The American College of Obstetricians and Gynecologists. 0029-7844/04/$30.00 Published by Lippincott Williams & Wilkins. doi:10.1097/01.AOG.0000119222.40241.fb